Effects of the Thai Health Improvement Profile intervention on the physical health and health behaviours of people with schizophrenia: A quasi‐experimental study

Physical health problems and unhealthy lifestyle behaviours are common in people with severe mental illness (SMI), leading to high levels of mortality.There is some evidence that nurse‐led interventions involving comprehensive health checks may be effective in improving physical health in people with SMI. This quasi‐experimental before‐and‐after study investigated the impacts of the Thai Health Improvement Profile (HIP‐T) on the physical health and health behaviours of people with schizophrenia over 1‐year. All 105 service‐users who volunteered to participate completed the study. There were significant reductions in mean BMI (?0.78 kg/m², P < .001) and bodyweight (?1.13 kg, P < .001) at post‐test. There was also a significant decrease in the total number of “red‐flagged” HIP‐T items, suggesting lowered potential health risks (P < .001). Overall, 23 patients (22%) were found to have moved to a healthier BMI classification after 1‐year. The findings suggest that the HIP‐T intervention has potential for improving the physical health of people with SMI when integrated into routine community mental health care.     

Training practice nurses to improve the physical health of patients with severe mental illness: effects on beliefs and attitudes

Annual health checks are recommended for patients with severe mental illness (SMI) as they are at high risk of cardiovascular disease. Ideally, these health checks should be carried out in primary care. Practice nurses are already competent in carrying out physical health checks, but might have misconceptions about mental illness, which is a barrier to offering the service. We used a mirror imaging study to establish the effectiveness of a training package for practice nurses that aims to address common misconceptions about the physical health of people with SMI. This 2-hour training package (Northampton Physical Health and Wellbeing Project) was delivered to eight practice nurses. Their misconceptions and beliefs were assessed before and after training. Motivation to work with community mental health workers was assessed after training. The practice nurses involved in the study rejected commonly held misconceptions about the physical health of people with SMI after training. Their attitudes towards their role in providing health checks appeared to be modified in a positive direction. Their motivation to work with community mental health workers also seemed to be enhanced. The Northampton Physical Health and Wellbeing Project training was effective in modifying practice nurses' misconceptions about physical health in people with SMI.     

Mental health nurses’ contributions to community mental health care: An Australian study

Australian mental health policy is focused on providing mental health care in the community setting and community mental health teams provide services to clients in a shared model with primary care. The historical literature reports that community mental health nurses’ experience high levels of stress and are often allocated the most complex and challenging clients managed by the team. Yet information on their specific roles remains limited. This paper reports on research conducted at one Australian public mental health service to identify the components of the community mental health nursing role and to quantify the time nurses spent in each component during the study period. Six focus groups were conducted with community mental health nurses to identify their perceived role within the team. Data analysis identified 18 components of which 10 were related to direct clinical contact with clients and eight covered administrative and care coordination activities. A data collection tool based on the findings of the focus groups was designed and nurses recorded workload data on the tool in 15‐min intervals over a 4‐week period. Seventeen nurses collected 1528 hours of data. Internal coordination of care was identified as the top workload item followed by clinical documentation and national data collection responsibilities supporting the complexity of the community mental health nursing role. The high rating attached to the internal coordination of care role demonstrates an important contribution that community mental health nurses make to the functioning of the team and the delivery of quality mental health care.     

Mental health nursing students’ views on their readiness to address the physical health needs of service users on registration

There is substantial evidence that people (service users) living with a serious mental illness experience poorer physical health than the general population and die prematurely from life‐threatening illnesses. Mental health nurses are best placed to address the physical health needs of service users but evidence points to numerous challenges, including a deficit in their proficiency to meet these needs. Nurse education and mental health services are being reshaped to better equip nurses with the skill set to meet the care needs of service users. The aim of the present study was to gain an in‐depth insight into final‐year mental health nursing students’ views (MHNS) of their preparation to address the physical health needs of service users. Using a qualitative exploratory approach, the views of final‐year MHNS learning experiences of physical care were explored through a focus group and in‐depth interviews. The focus group generated broad issues, which were then explored in semistructured, individual interviews. The transcribed audio‐taped data were analysed using a framework approach to identify the emerging key themes. The themes identified were the comprehensiveness of physical care content, delivery and method of teaching, exposure to physical care in practice, and confidence to address physical health needs. The findings of the present study indicate that there is a need to enhance both the theoretical and practical components of preregistration education for MHNS on physical care.     

Roles and functions of community mental health nurses caring for people with schizophrenia in Taiwan

Aims and objectives. The study aimed to understand the nursing roles and functions of public health nurses and home health nurses in Taiwan and the factors that affect nursing roles and functions of nurses that provide community mental health home visiting services. Background. Although community nurses provide more psychiatric home visiting services than other psychiatric professionals, little research on their roles and functions has been conducted. Design. Nursing roles and functions were developed through use of grounded theory method of Strauss and Corbin. Methods. Data were collected using semi‐structured face‐to‐face in‐depth interviews and unstructured non‐participant observations. The constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected using theoretical sampling. Final sample size in this study comprised a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home visiting. Public health nurses conducted a total of 16 (eight carers and eight clients) services and home health nurses conducted 16 (eight carers and eight clients) services. Results. Fourteen nursing roles were identified. These roles included assessor, supporter, educator, consultant, counselor, negotiator, harmoniser, collaborator, advocate, placement coordinator, resource provider, care provider, case manager and case finder. Moreover, several factors that affect nursing roles and functions in the community mental health home visiting service in Taiwan were also identified. Conclusion. This is the first study to identify the role of public health and home health nurses caring for people with schizophrenia in the community in Taiwan. Relevance to clinical practice. The recommendations based on the findings of this research can be used as a guide to improve the delivery of psychiatric home visiting services to community‐dwelling clients with schizophrenia and their carers.     

Chinese Health Improvement Profile for people with severe mental illness: A cluster‐randomized,controlled trial

The aim of the present study was to establish the feasibility of conducting a full‐scale trial and to estimate the preliminary effect of a Chinese Health Improvement Profile (CHIP) intervention on self‐reported physical well‐being of people with severe mental illness (SMI). The study used a parallel‐group, open‐label, cluster‐randomized, controlled trial (RCT) design. Twelve community psychiatric nurses (CPN) and their corresponding 137 patients with SMI were randomized into the CHIP or treatment‐as‐usual (TAU) groups. After training, the CPN completed the CHIP at baseline and 12 months, and the findings were used to devise an individualized care plan to promote health behaviour change. Patients were assessed at baseline and 6 and 12 months after starting the intervention. There was an observed positive trend of improvement on the physical component subscale of SF12v2 in the CHIP group compared to the TAU group after 12 months, but the difference did not reach statistical significance (P = 0.138). The mental component subscale showed a similar positive trend (P = 0.077). CHIP participants were more satisfied with their physical health care than TAU patients (P = 0.009), and the CPN were positive about the usefulness/acceptability of the intervention. There were significant within‐group improvements in the total numbers of physical health risks, as indicated by the CHIP items (P = 0.005). The findings suggest that it is feasible to conduct a full‐scale RCT of the CHIP in future. The CHIP is an intervention that can be used within routine CPN practice, and could result in small–modest improvements in the physical well‐being of people with SMI.     

Service and infrastructure needs to support recovery programmes for Indigenous community mental health consumers

Mental health is a major concern in Indigenous communities, as Indigenous people experience poorer health outcomes generally, and poorer social and emotional well‐being throughout their lives, compared to non‐Indigenous populations. Interviews were conducted with 20 mental health workers from a housing assistance programme for Indigenous clients with mental illness. Service and infrastructure needs identified to support clients were classified under the following overarching theme ‘supports along the road to recovery’. Subthemes were: (i) It is OK to seek help; (ii) linking in to the local community; (iii) trusting the workers; and (iv) help with goal setting and having activities that support their achievement. This paper highlights the importance of targeted housing and accommodation support programmes for Indigenous people to prevent homelessness, and the essential services and infrastructure required to support Indigenous clients’ mental health needs. These insights may inform service review, workforce development, and further research.     

Community psychiatric nursing: focus on effectiveness

The focus for provision of mental health services is now the community in most developed countries. Different ways of organizing community mental health services are evident in the literature. Community psychiatric nurses (CPNs) have a key role to play in these services but the literature indicates that the CPN role varies from area to area within different models of service provision. This paper presents the findings of a study in which 13 service users and 15 CPNs in five focus groups discussed the effectiveness of mental health service. Selected staff and service users were chosen from a representative range of community mental health services across Northern Ireland. Service users expressed concern at the variety of CPN and other professional roles within multidisciplinary teams and some CPNs expressed dissatisfaction with their role and with role boundaries within teams. These findings suggest that further work is needed within community mental health services to ensure the role of the CPN remains effective and develops to meet the needs of service users.     

Partnership in coping: an Australian system of mental health nursing

The paper identifies shortcomings of approaches used in organizing and delivering mental health nursing. It provides a rationale for the development of a new system of mental health nursing namely the Partnership in Coping system (PinC). This system has been developed by service users, clinical mental health nurses and an academic mental health nurse. Currently, it is undergoing trials in Western Australia. The PinC focuses on the strengths of clients. It uses the positive aspects of mental health nursing namely its holistic perspective, the length and nature of the informal contacts, the 'ordinariness' of relationships with clients and the nurse's knowledge of the clients' social and physical environments. It is a versatile system that can also be used across different mental health settings (community and inpatient facilities). The paper describes the philosophy behind the system, the concept of coping, the nature of the partnership between the client and nurse and their respective roles.     

Predictors and enablers of mental health nurses’ family‐focused practice

Family‐focused practice improves outcomes for families where parents have a mental illness. However, there is limited understanding regarding the factors that predict and enable these practices. This study aimed to identify factors that predict and enable mental health nurses’ family‐focused practice. A sequential mixed methods design was used. A total of 343 mental health nurses, practicing in 12 mental health services (in acute inpatient and community settings), throughout Ireland completed the Family Focused Mental Health Practice Questionnaire, measuring family‐focused behaviours and other factors that impact family‐focused activities. Hierarchical multiple regression identified 14 predictors of family‐focused practice. The most important predictors noted were nurses’ skill and knowledge, own parenting experience, and work setting (i.e. community). Fourteen nurses, who achieved high scores on the questionnaire, subsequently participated in semistructured interviews to elaborate on enablers of family‐focused practice. Participants described drawing on their parenting experiences to normalize parenting challenges, encouraging service users to disclose parenting concerns, and promoting trust. The opportunity to visit a service user's home allowed them to observe how the parent was coping and forge a close relationship with them. Nurses’ personal characteristics and work setting are key factors in determining family‐focused practice. This study extends current research by clearly highlighting predictors of family‐focused practice and reporting how various enablers promoted family‐focused practice. The capacity of nurses to support families has training, organizational and policy implications within adult mental health services in Ireland and elsewhere.     

Functionalism and holism: community nurses' perceptions of health

This paper reports the results of a study that was designed to explore and examine the perceptions of two groups of newly qualified community nurses about the factors they considered to be embedded within the concepts of health, health-enhancing behaviours at individual, family and community levels and their 'innermost self'. The research was exploratory in nature, and included two sample groups: group 1 comprised 16 newly qualified health visitors; group 2 comprised 16 newly qualified community mental health nurses. Purposive sampling was used and data were collected using semi-structured interviews. The group of health visitors perceived health in terms of physical fitness and functional states. At a global level they perceived the need to provide education on health matters. They gave generously to 'charities' and perceived the 'inner self' as 'that part that matters'. The group of community mental health nurses perceived health in terms of holism and being states. Their concept of health was related to listening to each individual's perception of what is 'right' and 'health-enhancing' for them. At a global level they considered the protection of the ozone layer and the promotion of a just and equitable society which focused on the reduction of poverty, to be key health-enhancing activities. They perceived their 'innermost self' to be 'that part of me that makes life worth living', and the soul. The findings have implications for developing new and creative approaches for teaching the holistic concept of health and healing. Educational activities could be designed which strive to ensure that nurses themselves have safe and health embracing opportunities for exploring all the elements that are embedded within the topic of health. Their role in facilitating holistic health promoting activities for all clients also needs to be addressed.     

The effects of student nurse community mental health placements on sufferers of mental health problems in the community

The effects which student nurses have on the care of clients with mental health problems in the community is an area which has seldom been studied With the closure of large psychiatric hospitals and the rise in community placements as part of Project 2000, an increasing number of students are being placed in the community The study gathers data from clients attending five self-help/support groups in the North Derbyshire area of England Analysis of the data challenges assumptions generally held by community psychiatric nurses (CPNs) that the presence of a third person, e g student/visitor, during a CPN home visit to the client is detrimental to the therapeutic interaction between the CPN and the client The findings are inconclusive but suggest that some client groups (possibly those with long-term mental health problems) may find the presence of a student during a CPN visit facilitative The study raises the issue of the student nurse/patient power relationship within a support group Findings suggest that membership of a support group is empowering to the client and illustrates that clients in the community have greater control over the involvement of student nurses in their care than patients in hospital Groups within the sample expressed a unanimous view that student nurse placements should be long enough to allow therapeutic nurse/client relationships to develop This is in direct contrast to the current Project 2000 Common Foundation Programme approach of short observational non-institutional placements     

'You don't talk about the voices': voice hearers and community mental health nurses talk about responding to voice hearing experiences

Aims and objectives. To explore service user and community mental health nurses views on responses to voice hearing experiences. Background. People who hear distressing auditory hallucinations (voices) are often in contact with mental health services. Nursing responses to this experience have been limited, although emerging evidence suggests some utilitarian alternative interventions, such as discussing the content and meaning of the voices. Design. Using exploratory interviews, this study investigated the response to voice hearing, with a purposive sample of community mental health nurses (n = 20) and service users (n = 20). This paper reports on a thematic content analysis of transcribed interviews, which highlighted differences in perspectives of voice hearers and the nurses supporting them. Results. Voice hearers reported that interventions from community mental health nurses were limited to reviews of medication, access to the psychiatrist and non‐directive counselling. They identified alternative needs, which involved talking more about the content and meaning of their voices. Conversely, community mental health nurses regarded their responses to voice hearing as being considered, titrated and demonstrating an awareness of the personal contexts of service users. These responses were however restricted by their perception of skill limitations. Conclusions. The contrasting views of nurses and users of services demonstrated in this study, reveal multiple social realities that represent a challenge to accepted professional responses in the provision of mental health care. Relevance to practice. People who hear voices express an interest in more helpful responses from community mental health nurses. The findings of this study indicate that nurses must begin to orientate themselves towards a more critical practice stance that encompasses available knowledge on the voice hearing experience.     

Do adult mental health services identify child abuse and neglect? A systematic review

Child abuse and neglect play a causal role in many mental health problems. Knowing whether users of mental health services were abused or neglected as children could be considered essential for developing comprehensive formulations and effective treatment plans. In the present study we report the findings of a systematic review, using independent searches of three databases designed to discover how often mental health staff find out whether their clients were abused or neglected as children. Twenty‐one relevant studies were identified. Most people who use mental health services are never asked about child abuse or neglect. The majority of cases of child abuse or neglect are not identified by mental health services. Only 28% of abuse or neglect cases identified by researchers are found in the clients’ files: emotional abuse, 44%; physical abuse, 33%; sexual abuse, 30%; emotional neglect, 17%; and physical neglect, 10%. Between 0% and 22% of mental health service users report being asked about child abuse. Men and people diagnosed with psychotic disorders are asked less than other people. Male staff ask less often than female staff. Some improvement over time was found. Policies compelling routine enquiry, training, and trauma‐informed services are required.     

Left alone – Swedish nurses’ and mental health workers’ experiences of being care providers in a social psychiatric dwelling context in the post‐health‐care‐restructuring era. A focus‐group interview study

Scand J Caring Sci; 2010; 24; 427–435
Left alone – Swedish nurses’ and mental health workers’ experiences of being care providers in a social psychiatric dwelling context in the post‐health‐care‐restructuring era. A focus‐group interview study The professional role of nurses and mental health workers in social psychiatry is being re‐defined towards a recovery, client‐focused perspective. Approximately 0.7 percent of the adult population in Sweden suffers from severe mental illness leading to a need for community services. The primary aims of the Mental Health Reform in 1995 in Sweden were to improve the quality of life for people with severe, long‐term mental illness and, through normalization and integration, enhancing their opportunities to communicate with and participate in society. This study examines nurses’ and mental health workers’ views and experiences of being care providers in a municipal psychiatric group dwelling context when caring for clients suffering from severe mental illness. Three focus group interviews were made and thematic content analysis was conducted. Four themes were formulated: ‘Being a general human factotum not unlike the role of parents’, ‘Having a complex and ambiguous view of clients’, ‘Working in a mainly ‘strangled’ situation’, and ‘Feeling overwhelming frustration’. The staff, for instance, experienced a heavy workload that highly involved themselves as persons and restricted organization. The individual relational aspects of the nursing role, the risk of instrumentalizing the staff due to an organizational economical teleopathy (meaning a pathological desire to react goals), and the high societal demands on accomplishing the Mental Health Reform goals are discussed. To redefine the professional role of nurses and mental health workers in the community, in Sweden known as municipality, they need support in the form of continuously education, supervision, and dialogue with politicians as well as the public in general.     

Telephone survey of service‐user experiences of a telephone‐based mental health triage service

The participation of service users in all aspects of mental health service delivery including policy development, service planning and evaluation is increasingly an expectation of contemporary mental health care. Although there are a growing number of publications reporting service‐user perspectives in the evaluation of mental health services, little attention has been paid to the views of service users about mental health triage services. The purpose of the study reported here was to examine service‐users' (consumers and informal carers) experiences of a telephone‐based mental health triage service. Using a framework developed from the World Health Organisation's elements of responsiveness, we conducted structured telephone interviews with service users who had contacted a telephone‐based mental health triage service in regional Victoria, Australia. The main findings of the study were that consumers experienced more difficulty than carers in accessing the service and that, although most participants were satisfied, only a minority reported being involved in decision‐making. Further work is needed to improve accessibility of mental health triage services and to investigate barriers to consumer self‐referral. Professional development and practice support systems should be established to support mental health triage nurses in the development of collaborative, consumer‐focused care.     

Perceptions of mental health nurses and patients about health promotion in mental health care: a literature review

The aim of this review was to examine the perceptions of patients with mental disorders and mental health nurses of health promotion targeting physical activity and eating habits in mental health care. An electronic search strategy was conducted. Furthermore, references were searched by hand-searching the reference lists of the retrieved articles from the electronic databases. The literature on perceptions of health promotion and lifestyle interventions in mental health care principally consist of qualitative studies using interviews and focus groups. Positive perceptions of both mental health nurses and patients towards health promotion targeting physical activity and eating habits in mental health care were identified. Contrary, several barriers for integrating healthy lifestyles into the daily life of patients were described. Patients usually want to learn more about healthy lifestyles, but see the ability to change their physical health as beyond their control. In this sense, support from mental health nurses is considered as important. Despite the awareness of the importance of health promotion in mental health care, it appears that visions and attitudes towards the potential of health promotion are in need of change.     

Providing physical health care for people accessing mental health services: Clinicians’ perceptions of their role

The prevalence of health risk behaviours and associated poor physical health is high in people with severe mental illness. Mental health service guidelines and policies stipulate that mental health services should address physical health of people who access services. This study reports results from a large, interdisciplinary, cross‐sectional study exploring mental health clinicians’ (n = 385) views of role legitimacy in physical health service provision. All disciplines reported that mental health clinicians have a role to play in addressing the physical health of consumers. Among mental health clinicians, psychiatrists and mental health nurses received higher endorsement than allied health clinicians in relation to the provision of physical health care, with primary care providers including general practitioners also ranking highly. As community mental health services routinely appoint allied health staff to case management roles, a challenge for services and a challenge for clinicians are to ensure that physical health and the effects of medication are monitored appropriately and systematically. Online and telephone support services received relatively lower endorsement. As the availability of nonface to face services increases, there is a need to explore their utility in this population and where appropriate promote their uptake.     

Access to Physical Health Care for People with Serious Mental Illness: A Nursing Perspective and a Human Rights Perspective-Common Ground?

Relative to the general population, people with serious mental illness (SMI) experience elevated risks of physical disease and illness and live shorter lives. A human rights perspective argues that people with serious mental illness have a right to equal access to physical health care. Nurses in mental health services can contribute to improving the availability and accessibility of physical health care. This study, involving focus group interviews with nurses in a large regional and rural mental health care district of Queensland, Australia, revealed significant problems in access to physical health care for service users. The current article reports on our exploratory analysis of nurses’ views and perceptions to identify (1) orientation of nurses to human rights, and (2) access of consumers with SMI to general practitioner services. It was rare for nurses to raise the topic of human rights, and when raised, it was not as a strategy for improving access to physical health care services that they felt consumers with SMI greatly needed. Two main themes were identified as causes of poor access: clinical barriers to physical care and attitudinal barriers to physical care. In light of these results, the authors explore a human rights perspective on access and how this provides an inclusive lobbying umbrella under which nurses and other groups can pursue access to physical health services that are adequate, accessible, and non-discriminatory. The article then discusses the implications for these findings for the value of human rights as a perspective and means of increasing physical health of people with SMI.